Hypertrophic Pachymeningitis Possibly Secondary to Otitis Media

TL;DR

A 46-year-old woman with hearing loss and headache was found to have hypertrophic pachymeningitis possibly linked to otitis media, which improved with corticosteroid treatment.

Contribution

This case highlights a potential link between otitis media and hypertrophic pachymeningitis, suggesting postinfectious immune mechanisms.

Findings

The patient's symptoms and imaging findings indicated progressive involvement of the tentorium cerebelli.

High-dose corticosteroid therapy led to significant symptom relief, implying an immune–inflammatory cause.

The case suggests a possible secondary origin of hypertrophic pachymeningitis from otitis media.

Abstract

This study describes a 46‐year‐old female patient who initially presented with hearing impairment and subsequently developed a headache as the predominant symptom, accompanied by the involvement of multiple cranial nerves, including the optic, vestibulocochlear, and trigeminal nerves. Cerebrospinal fluid pressure progressively increased, and imaging demonstrated progression from unilateral to bilateral involvement of the tentorium cerebelli. Clinically, the patient’s hypertrophic pachymeningitis was considered associated with otitis media. After receiving high‐dose corticosteroid pulse therapy, the patient experienced marked relief of the headache and associated symptoms, which was presumed to be related to postinfectious immune–inflammatory mechanisms.

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